Abstract

The purpose of this study was to clarify the process for rectal cancer patients to rebuild their lives following total pelvic exenteration. The subjects in this study were 8 rectal cancer patients who had undergone total pelvic exenteration within the past 5 years, and who currently return for outpatients follow-up visits. The study data was collected by semi-structured interviews, and were analyzed by a qualitative and inductive method. This study was approved by the clinical ethics committee of the concerned hospital.

Subjects experienced “problems encountered following total pelvic exenteration”, and pursued “coping behavior to rebuild their lives following total pelvic exenteration”. In the course of dealing with these problems repeatedly, the subjects experienced a “development of a sense of self-affirmation”, and obtained “a sense of satisfaction with the meaning of life”. In addition, it was clarified that the “need to pursue being happy with themselves” promoted the acquisition of coping behavior, and the “support situation provided by a supportive environment to the patients following total pelvic exenteration” affected the whole process of life reconstruction.

The core thing of the process that rectal cancer patients rebuilding their lives after total pelvic exenteration was their “development of a sense of self-affirmation”, which was promoted by the success of such coping behavior. Deficiencies in these coping behavior and the lack of a supportive environment caused failures in the “development of a sense of self-affirmation”.

In conclusion, it was found that encouraging the “development of a sense of self-affirmation” was the most important factor in rebuilding patients’ lives following total pelvic exenteration, and in feeling satisfaction in their lives.

Abstract

PURPOSE：Weight gain is a remarkable side effect of chemotherapy for breast cancer patients. This study aimed to identify weight gain patterns and factors among women receiving several major types of chemotherapy regimen.

PATIENTS AND METHODS：Data were collected on 93 Japanese women receiving chemotherapy with FEC, TC, DOC or PTX for breast cancer. We prospectively evaluated weight, body mass index（BMI）, body composition, serum protein and serum cholesterol before（baseline）and after treatment（post-treatment）.

RESULTS：There was no significant change in weight/BMI from baseline to the post-treatment in either the FEC group or the PTX group. The rate of weight increase correlated significantly with the body fat mass in both the FEC group（p＜0.000）and DOC group（p＝0.004）. Participants in the FEC group only showed a significant increase in serum cholesterol after treatment（p＜0.000）. The median change in weight was＋2.30kg in the TC group（p＝0.002）and＋3.25kg in the DOC group（p＝0.003）. There was a significant increase in extracellular water（p＝0.002）and a decrease in serum protein（p＜0.000）in the TC group, similar to those seen in the DOC group（p＝0.006/p＝0.025）. The mean increase rates were 3‒4％ for body weight and 5‒6％ for extracellular water.

CONCLUSIONS：Although no significant change in weight gain was seen in women receiving the FEC regimen, there would be some possibility of sarcopenic obesity from weight increase associated with body fat mass. The weight gain in patients receiving either the TC or DOC regimen was possibly owing to Docetaxel-induced fluid retention. Therefore, weight management during chemotherapy for breast cancer patients would be expected according to the features associated with the regimen type.

Abstract

The purpose of this research is to identify behavior and ideas of self-care by renal cell carcinoma patients undergoing immunotherapy in outpatient settings. In this research, each of five renal cell carcinoma patients who had started immunotherapy within one year was interviewed three times. Data were collected using a semi-structured interview method guided by Orem’s Self Care Theory and other self-care researches for cancer patients. Self-care was defined as behavior and ideas with which patients maintain their life, health, and wellness by themselves. Self-care data were collected with selfcare requirements for the patients. The verbatim record of the interviews with the patients was analyzed to pick out and name behavior and ideas of self-care and self-care requirements from each patient. A similar categorization of self-care and self-care requirements was obtained from each patient.

The patients, all in their 50s, diagnosed with renal cell carcinoma, recognized the need to start immunotherapy, considering their condition and the limited treatments available for them. The expensive treatments they had had turned out to be not effective, and they became uncertain and apprehensive about the cure of their cancer. They experienced flu like symptoms and fatigue as side effects and felt weak both physically and mentally. They need to take time for outpatient treatment and to continue assuming their role at home and at work. The following five characteristics of self-care for the patients, specified in brackets［］, were identified: the patients were trying to keep balance between ［continuing to assume their social roles］ and [continuing to undergo their treatment with its effectiveness uncertain], as they try to［adjust and control their negative emotions to live with illness of which cure is uncertain］. They also ［controlled discomfort of side effects］ and ［maintained their physical condition］ enough to continue assuming their social roles and undergoing their treatment. I found the following in this study：patients realize that they cannot escape from the fact that they have cancer；therefore they have made a decision to reconstruct their life with a new found perspective in four characteristic areas of self-care except for the area of［controlling the discomfort of side effects］

Abstract

The purpose of this study was to clarify the awareness of young people and their feelings about cervical cancer screening, and to investigate factors affecting screening behavior. A self-administered questionnaire survey was conducted among 352 female college and university students in their early 20s. The questionnaire consisted of subject demographics, plus 15 items on knowledge of, and 24 items on feelings about cervical cancer screening. The questionnaire was answered by 176 students. After excluding incomplete questionnaires, the remaining 168 responses were analyzed using descriptive statistics such as the χ² test and the Mann-Whitney U test. The results showed that only a low proportion of students had undergone screening and the knowledge of non-medical students about cervical cancer screening was poor. Many young people understood the seriousness of cervical cancer, but thought that it was a disease irrelevant to them. In addition, they had a poor awareness about the concrete details of screening and felt that there were disadvantages with screening. However, a higher proportion of students who knew about infection routes and increased incidence in the young felt the necessity of screening and stated their intention to receive screening. Furthermore, female students expressed their intent to take action to receive screening, if given any opportunity. From these findings, the following emerged as important points to encourage young females to undergo screening：awareness of the morbidity of cervical cancer and the benefit of screening must be raised；information on infection routes should be provided；awareness of the increased incidence of cervical cancer in the young should be raised；and education should be provided about the actual screening process.

Abstract

The purpose of this study is to clarify the structure of coping with chemotherapy-related adverse events in patients with relapsed leukemia and to examine the effective management of adverse events. This study using semi-structured interviews explored coping of seven hospitalized patients with relapsed leukemia. Data were analyzed using the grounded theory approach. The core category of the patient’s coping process was “learning efficient coping without wasting energy”. The coping process consisted of four main categories：‘Dealing with one’s disease by controlling symptoms’, ‘Proper control of adverse events’, ‘Continue effective preventive measures’, ‘Accept treatment with will to live’

Patients with relapsed leukemia who aim to complete severe chemotherapy had to learn efficient coping behavior that doesn’t waste energy to avoid exhaustion. Nurses need to understand the structure of coping which patients learned through their experience, and examine the manner of delivering information and educational intervention to patients.

Abstract

The purpose of this study was to clarify external consultation needs in the cancer nursing field. Focus group interviews were conducted with 3 directors of the nursing service departments, 20 ward nursing managers and 22 nurses from designated cancer hospitals, to identify external consultation needs. The data collected were analyzed using content analysis.

Regarding external consultation needs in the cancer nursing field, a total of 7 categories were extracted─3 from nursing service department directors, 3 from nursing managers and 1 from nurses. External consultation needs identified were divided broadly into 2 categories：problems directly relating to patient care, problems relating to support for nurses. The following relate to external consultation needs：‘Strengthening the capacity of nursing practice to promote cancer treatment’, ‘development of human resources for cancer nursing services’, ‘training of novice nurses’, ‘creating organizational system for making best use of specialists’, ‘career development support’, ‘mental health care for nursing staff ’ and ‘self-control’. The study found that nursing staff feel that since there are limitations to addressing these problems only with internal staff, they wish to use external resources such as external consultants, if easily accessible.

Suggested roles for outside consultants include promoting consultation flexibly according to state policy and the advancement of cancer treatment, strengthening the capacity of cancer nursing practice, and to support the nurses.

Abstract

The purpose of this study was to elucidate the difficulties encountered in the performance and management of duties by 14 working cancer patients receiving first chemotherapy. Data were collected using semi-structured questionnaires to interview at the start of chemotherapy, and after the 1st, 2nd, and 3rd month. Collected data were analyzed to extract responses concerning difficulties and management, further categorizing them according to similarities in semantic content.

There were 7 categories of difficulties encountered at the commencement of chemotherapy, e.g., “I am worried whether I will be physically able to perform my duties”, “I do not know what impact the illness and chemotherapy will have on my duties”. Regarding newly revealed difficulties, there were 6 categories identified after the 1st month, e.g., “Although I want to continue performing my duties, I am unable to”, “I do not know how to relate to other people”. Three categories were revealed after the 2nd month, e.g., “performing my duties and receiving chemotherapy simultaneously is difficult”, “I have difficulty in coping with side effects”, and 1 identified after the 3rd month, e.g., “it is difficult to relate to others”. For management difficulties, 11 categories were revealed at the commencement of the chemotherapy, e.g., “do not think too much”, “involve others”. Regarding newly identified categories, there were 5 categories after the 1st month, e.g., “remain positive when receiving chemotherapy”, 3 categories after the 2nd month, e.g., “I try to discharge my duties as much as I can”, and 2 categories after the 3rd month, e.g., “express my intentions in an assertive manner”.

It was demonstrated that working cancer patients attempted to make positive efforts, both physically as well as psychologically, by monitoring their physical condition and making use of support provided by other people；this in spite of being concerned about their physical strength, having difficulties in interacting with others, as well as being uncertain about possible implications of the illness and chemotherapy. For patients to be proactive in receiving chemotherapy by combining their social roles with those of patients, it is necessary for them to have certain foresight and deal with side effects of self care, thereby enabling them to interact with other people in a positive and assertive manner.

Abstract

This study aimed to reveal the uncertainty and coping of cancer patients undergoing radiotherapy in order to gain insight about nursing support that helps patients independently face treatment and cope with uncertainty until its completion. Study participants were eight cancer patients undergoing curative radiotherapy for the first time. Interviews were conducted using a semi-structured questionnaire, and the data obtained was qualitatively and inductively analyzed. Six main categories were identified for uncertainty experienced by cancer patients undergoing radiotherapy：“the existence of the radiation itself is amorphous,” “I can’t judge if radiotherapy is appropriate,” “the future course of treatment is unpredictable,” “treatment is too complicated to fully comprehend,” “it is hard to grasp my illdefined physical state,” and “I can’t control my situation.” For the patients’ forms of coping, six main categories were elicited as follows：“I interpret things in my own way,” “I collect information on my own,” “I intentionally avoid thinking about it,” “I shut up concerns inside myself,” “I continue the radiotherapy that needs to be done,” and “I sort out my feelings so I can be certain about the future.” This suggests that, in an uncertain situation, patients find meaning in continuing radiotherapy and repeatedly work to cope with uncertainty, thereby obtaining a new perspective on uncertainty.